How Sugar and Refined Carbohydrates Can Aggravate Fibromyalgia and Chronic Illness Symptoms
Most people with fibromyalgia (FM) understand that there is a strong link between their diet and the severity of their symptoms. Research shows that certain foods can cause inflammation in your body, amplifying the chronic inflammation that underlies FM. Increased muscle and joint pain, cognitive difficulties (“fibro fog”), fatigue, and low-quality sleep patterns, all common symptoms of FM, are therefore significantly affected by dietary choices.
Today, we’ll look at one of the leading culprits of inflammation in our modern diet – sugars (and their close cousins refined carbohydrates). The research I'm sharing with you implicates sugar as a common trigger for FM and chronic illness symptoms. We'll conclude with some practical tips for managing your sugar intake. This may include experimenting with a low-glycemic or keto diet, in consultation with a doctor or dietitian.
The Role of Inflammation in Chronic Illness
Inflammation is the body's natural response to injury or infection, involving the release of chemicals to promote healing. However, chronic inflammation, which persists over a long period, can lead to tissue damage and contribute to a range of health issues, including chronic pain conditions like fibromyalgia. Extensive research has shown that inflammation plays a crucial role in the pathophysiology of fibromyalgia, contributing to pain and other symptoms (1).
Sugar = Inflammation: The Scientific Evidence
Many studies have demonstrated that high sugar intake leads to the production of pro-inflammatory cytokines, which are signalling molecules that promote inflammation (2). These cytokines can worsen symptoms in individuals with chronic illnesses, including fibromyalgia.
Sugar and Pro-Inflammatory Cytokines: A study published in the American Journal of Clinical Nutrition found that consuming high amounts of sugar leads to elevated levels of C-reactive protein (CRP), a marker of inflammation (3). Elevated CRP levels are associated with increased pain and fatigue in fibromyalgia patients (4).
Glycemic Index and Inflammation: The glycemic index is a measure of how quickly a food causes an individual’s blood sugar levels to rise. The measure ranks food on a scale of zero to 100. Foods with a high glycemic index, or GI, are quickly digested and absorbed, causing a rapid rise in blood sugar. A diet high in high-GI foods has been shown to increase inflammation and oxidative stress, contributing to chronic pain (5).
Low Carb and Ketogenic Diet: In a study published in 2023 the authors concluded that nervous system sensitization and inflammation, both of which occur in chronic pain, may be improved by a low-carbohydrate diet. (6)
How Sugar Exacerbates Fibromyalgia Symptoms
Increased Pain Sensitivity: Sugar consumption can lead to fluctuations in blood glucose levels, which may affect pain sensitivity. A study in the journal Pain found that hyperglycemia (high blood sugar) can enhance pain perception through its effects on the nervous system (7). For fibromyalgia patients, who already have heightened pain sensitivity, this can result in more intense and frequent pain episodes.
Fatigue and Energy Crashes: One of the hallmark symptoms of fibromyalgia is chronic fatigue. While sugar provides a rush of energy it is followed by a rapid drop in blood sugar levels, leading to fatigue and energy crashes. This debilitating cycle amplifies the fatigue already experienced by fibromyalgia patients.
Sleep Disturbances: Another hallmark symptom of FM is sleep disturbances. Sugar can interfere with sleep quality by causing fluctuations in blood sugar levels and increasing the risk of sleep apnea. Poor sleep quality further contributes to the severity of fibromyalgia symptoms. (8) (9)
Mood Swings and Cognitive Impairment: High sugar intake has been linked to mood swings and cognitive impairment. Long-term and cross-sectional studies in humans have suggested links between the consumption of added sugars and reduced cognitive function, poor memory performance, and higher risk of cognitive impairment (10). In other words, high sugar consumption can potentially amplify the effects of brain fog in someone with FM.
Impact of Sugar on Other Chronic Conditions
While in this post fibromyalgia has been the focal point, it is important to acknowledge that sugar's impact on inflammation and pain extends to other chronic pain conditions as well. Here are several that are frequent co-morbidities with FM.
Rheumatoid Arthritis: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints. Studies have shown that high sugar intake can worsen inflammation and pain in RA patients (11).
Osteoarthritis: Osteoarthritis is a degenerative joint disease where inflammation plays a key role. Research indicates that a diet high in sugar can increase the risk of developing osteoarthritis and exacerbate symptoms in those who already have the condition (12).
Chronic Headaches and Migraines: High sugar consumption has been associated with an increased frequency of headaches and migraines. Inflammation and fluctuations in blood sugar levels are believed to contribute to these symptoms (13).
Sugar is Everywhere – Taking Control of Your Sugar Intake
As someone with Celiac Disease, I’ve learned to read labels on prepared foods very carefully. While scanning through lists of ingredients and looking for fugitive sources of gluten, I’ve learned that sugar is added to many prepared foods, and not just the obvious ones like cookies, soda, and candy. Even in seemingly healthy products such as bread, salad dressings, and flavoured yogurt, there are often large amounts of added sugar.
Given the significant impact of sugar on inflammation and chronic pain, reducing sugar intake can be a crucial step in managing fibromyalgia symptoms. As always, I highly recommend that you consult with your medical professional or a dietician before undertaking major changes to your diet or lifestyle.
Read Labels: Many processed foods contain sugars, often disguised under various names such as sucrose, glucose, dextrose, fructose, and corn syrup. There are dozens more, including natural sweeteners such as honey, maple syrup, and agave nectar. Learning to read labels and identify hidden sugars and high glycemic ingredients is an eye-opener and will empower you to make healthier choices when you shop.
Choose Whole Foods: Always try to consume whole, unprocessed foods. Fresh fruits, vegetables, lean proteins, and whole grains provide essential nutrients and carbohydrates without added sugars.
Limit Sugary Beverages: Sugar-laden drinks like soda, fruit juices, and energy drinks should be avoided. Instead, choose water, herbal teas, or drinks flavoured with fruits and natural ingredients (lemon, cucumber, berries etc.).
Healthy Snacking: Replace sugary snacks with healthier options like nuts, seeds, and low-glycemic fruits such as berries.
Cook at Home: Preparing meals at home allows you to control the ingredients and reduce added sugars. Experiment with recipes that use natural sweeteners like honey or maple syrup in moderation.
Investigate a Keto or Low Glycemic Diet: If you’re unsure how to incorporate a lower carbohydrate/low GI diet into your lifestyle there are many resources available to teach you the basics and suggest menus. A low glycemic diet will eliminate the worst sugars and carbs from your diet. The ketogenic diet, currently in vogue, is a low-carb diet that incorporates higher levels of healthy fats to force the body into ketosis (deriving energy from fats, not carbs).
Manage Cravings: Sugar cravings can be challenging to overcome. Eating regular, balanced meals with a good mix of protein, healthy fats, and fiber can help stabilize blood sugar levels and reduce cravings. Staying up late, and sleep deprivation can also trigger cravings for a quick energy fix. Sticking to your eating and sleeping schedules will make your cravings more manageable.
Conclusion
Sugar's impact on chronic illness symptoms, including fibromyalgia, is undeniable. By promoting inflammation, increasing pain sensitivity, and contributing to fatigue, sleep disturbances, and cognitive issues, high-glycemic foods exacerbate the debilitating symptoms of fibromyalgia and other chronic pain conditions. Understanding this relationship is crucial for individuals looking to manage their symptoms effectively. By reducing sugar and high-glycemic foods, people with fibromyalgia can enjoy a better quality of life with fewer fibro flares.
Have you noticed that sugar triggers any symptoms for you?
References
Bazzichi, L., Rossi, A., Massimetti, G., Giacomelli, C., Sernissi, F., Consensi, A., ... & Bombardieri, S. (2007). Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clinical and Experimental Rheumatology, 25(2), 225-230.
Ma X, Nan F, Liang H, Shu P, Fan X, Song X, Hou Y, Zhang D. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022 Aug 31;13:988481. doi: 10.3389/fimmu.2022.988481. PMID: 36119103; PMCID: PMC9471313.
Liu, S., Manson, J. E., Buring, J. E., Stampfer, M. J., Willett, W. C., & Ridker, P. M. (2002). Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. American Journal of Clinical Nutrition, 75(3), 492-498.
Lombard, J., Doraiswamy, P. M., & Pottala, J. V. (2014). A potential role of C-reactive protein in cognitive decline in elderly with fibromyalgia. Journal of Psychiatric Research, 50(3), 31-35.
Galland, L. (2010). Diet and inflammation. Nutrition in Clinical Practice, 25(6), 634-640.
Field R, Field T, Pourkazemi F, Rooney K. Low-carbohydrate and ketogenic diets: a scoping review of neurological and inflammatory outcomes in human studies and their relevance to chronic pain. Nutrition Research Reviews. 2023;36(2):295-319. doi:10.1017/S0954422422000087
Kao, K. K., Yin, M. C., & Lin, M. C. (2008). Hyperglycemia enhances pain perception and reduces analgesia produced by lipopolysaccharide. Pain, 135(3), 322-331.
Alahmary SA, Alduhaylib SA, Alkawii HA, et al. Relationship Between Added Sugar Intake and Sleep Quality Among University Students: A Cross-sectional Study. American Journal of Lifestyle Medicine. 2022;16(1):122-129. doi:10.1177/1559827619870476
Roehrs, T., Hyde, M., Blaisdell, B., Greenwald, M., & Roth, T. (2008). Sleep loss and REM sleep loss are hyperalgesic. Sleep, 29(2), 145-151.
Gillespie KM, White MJ, Kemps E, Moore H, Dymond A, Bartlett SE. The Impact of Free and Added Sugars on Cognitive Function: A Systematic Review and Meta-Analysis. Nutrients. 2023 Dec 25;16(1):75. doi: 10.3390/nu16010075. PMID: 38201905; PMCID: PMC10780393.
Hu, Y., Sparks, J. A., Malspeis, S., Costenbader, K. H., & Karlson, E. W. (2017). Long-term dietary quality and risk of developing rheumatoid arthritis in women. Annals of the Rheumatic Diseases, 76(8), 1357-1364.
Cao, Y., Tang, S., & Duan, H. (2017). High-sugar diet promotes osteoarthritis progression via macrophage recruitment and STAT3 activation. Journal of Cellular Physiology, 232(12), 3876-3884.
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of migraine: a disorder of sensory processing. Physiological Reviews, 97(2), 553-622.
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